Provider Demographics
NPI:1891459285
Name:CRABTREE, SHAWN DOUGLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DOUGLAS
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CRAB ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1349
Mailing Address - Country:US
Mailing Address - Phone:606-485-4673
Mailing Address - Fax:606-485-4600
Practice Address - Street 1:411 CRAB ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1349
Practice Address - Country:US
Practice Address - Phone:606-485-4673
Practice Address - Fax:606-485-4600
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty